de Macedo João Paulo Cassiano, Nabuco-de-Araujo Pedro Henrique Xavier, de Campos José Ribas M, Pêgo-Fernandes Paulo M, Terra Ricardo M
Thoracic Surgery Department, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
Thoracic Surgery Department, Instituto do Câncer do Estado de São Paulo (ICESP), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
Clinics (Sao Paulo). 2025 May 15;80:100679. doi: 10.1016/j.clinsp.2025.100679. eCollection 2025.
Chest wall reconstruction plays an important role in the outcomes of chest wall resection. However, there being a huge variety of materials at disposable, the best option has not yet been well defined. The Vitagraft® is a synthetic and absorbable material, that works as an osteoinduction and osteoconduction for bone regeneration. It consists of a β-phase Tricalcium Phosphate Ceramic (β-TCP) and the Polylactic Glycolic Acid Polymer (PLGA). Therefore, this study intends to assess the safety of Vitagraft® use in the chest wall.
A prospective study, in which the patient's chest was reconstructed with Vitagraft®. Each patient was followed after the procedure for at least three months. The following variables were considered: KPS, ECOG, preoperative treatment, defect size, myocutaneous flap, the time between surgeries, complications, and mortality.
Eight resections were performed due to tumor findings. One reconstruction was a treatment for sternal cleft, another for Poland's syndrome, and finally as a consequence of late sternal dehiscence. Primary closure was performed in 63.6 % of the patients. Vitagraft® was used in association with mesh in eight cases. Reoperation was required in two cases, and prosthesis removal for one of them. Respiratory failure and major systemic complications were not evidenced.
In the present study, the first to assess Vitagraft® in chest wall reconstruction, the second operation was necessary for 28 %, and removal was mandatory for 14 %. Until now, chest postoperative tomography has been showing good prosthesis biocompatibility. The authors need further details about the ossification time especially relating to the size of the resection.
胸壁重建在胸壁切除术后的结果中起着重要作用。然而，由于有大量材料可供使用，最佳选择尚未明确界定。Vitagraft®是一种合成可吸收材料，可作为骨再生的骨诱导和骨传导材料。它由β相磷酸三钙陶瓷（β-TCP）和聚乳酸乙醇酸聚合物（PLGA）组成。因此，本研究旨在评估Vitagraft®在胸壁使用中的安全性。
一项前瞻性研究，其中用Vitagraft®对患者胸部进行重建。术后对每位患者进行至少三个月的随访。考虑了以下变量：KPS、ECOG、术前治疗、缺损大小、肌皮瓣、手术间隔时间、并发症和死亡率。
因肿瘤发现进行了8例切除术。1例重建用于胸骨裂治疗，另1例用于波兰综合征，最后1例是由于晚期胸骨裂开。63.6%的患者进行了一期缝合。8例使用Vitagraft®联合网片。2例需要再次手术，其中1例取出假体。未发现呼吸衰竭和严重全身并发症。
在本研究中，首次评估Vitagraft®在胸壁重建中的应用，28%的患者需要二次手术，14%的患者必须取出假体。到目前为止，胸部术后断层扫描显示假体生物相容性良好。作者需要进一步了解骨化时间的详细信息，特别是与切除大小相关的信息。
